Ghana’s new three-tier healthcare model could cover patients from the village clinic to the operating theatre, but only if strict referral rules and reliable supplies hold, an IMANI analysis has found. Research Associate Ransford Brobbey reviewed the structure Health Minister Kwabena Mintah Akandoh outlined in a briefing on October 6, 2026.
The model places Free Primary Healthcare at the base, the National Health Insurance Scheme in the middle and the MahamaCares fund at the top for catastrophic illness. Mr Brobbey flags three risks, namely overuse, supply gaps, and patients skipping lower facilities, and recommends mandatory electronic referrals to protect the design.
“The effectiveness of this three-tier architecture hinges upon strict gatekeeping protocols.”
Ransford Brobbey, IMANI Research Associate
Mr Brobbey describes Free Primary Healthcare as “a decisive philosophical pivot from an exclusively curative healthcare orientation to an integrated preventative-promotive paradigm.”
The programme operates across 135 districts and targets 150 in the immediate term, within a budget of GH¢1.5 billion. It removes all out-of-pocket charges at Community-based Health Planning and Services compounds, health centres and polyclinics.
President Mahama has promoted the free healthcare revolution before an international audience, and the report shows how the scheme is paid for at home.
Two Payment Channels Fund Primary Care
The report explains that the programme uses two financing routes. For routine illness such as malaria, acute respiratory infections and diarrhoeal diseases, facilities claim reimbursement after treating patients. That arrangement keeps their revolving drug funds stocked, according to Mr Brobbey.
For prevention, the state pays ahead. Quarterly population-based transfers of about GH¢35 million finance community health officers, who visit households to screen residents with mobile diagnostics, glucometers and blood pressure apparatus. The design, in Mr Brobbey’s reading, rewards outreach and not only treatment.
The second tier belongs to the National Health Insurance Scheme. Mr Brobbey writes that it completes the continuum of care at secondary and referral hospitals, and that patients need a formal subscription to use it. Earlier reporting shows that active membership has reached 70%.
Capacity is growing at this level too. The report notes plans for 160-bed regional hospitals in the Oti, Western North and Savannah regions, and The Vaultz News has covered the regional referral hospitals planned for them.
MahamaCares Covers the Costliest Illness
At the top sits the Ghana Medical Trust Fund, known as MahamaCares. Mr Brobbey describes it as a GH¢2 billion specialised statutory fund for chronic, catastrophic non-communicable diseases.
It covers advanced oncology, chronic dialysis and open-heart surgery. The report states that these conditions currently account for 40% to 45% of adult deaths in health institutions. The government has set aside money for the Ghana Medical Trust Fund as part of its health agenda.
Ransford Brobbey warns that the base tier depends on stock as much as money. Distributing 24,000 diagnostic units and 7,000 motorbikes improves transport and screening capacity, he acknowledges.
It cannot make up for shortages of rapid diagnostic test kits and first-line anti-infective medicines at community clinics, he cautions, if central medical stores fall behind on procurement.
The report names two behavioural risks. The first is moral hazard. “Non-contributory primary access without explicit co-payments creates potential moral hazard, encouraging unnecessary facility attendance for minor ailments and overburdening primary health workers.”
The second is bypassing. Without strict statutory disincentives, Mr Brobbey explains, patients may keep going straight to secondary and tertiary emergency rooms for minor ailments. That would dilute the role of primary centres as the gate to the system.
Referral Rules as the Remedy
Ransford Brobbey’s answer is legislation. He recommends statutory protocols that require patients to obtain electronic referrals from accredited Free Primary Healthcare centres before they can claim NHIS secondary reimbursement. Higher-tier facilities, he argues, should be reserved for true emergencies and complex pathology.
The report is an analysis built largely on the Minister’s own briefing and later interviews, so its figures await independent confirmation. The tests it sets are practical. Clinics must stay stocked, referrals must be enforced, and patients must find that the lower tiers work.
If those conditions hold, the model could give every Ghanaian a clear path through the system, whatever the illness.
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